My wife suffers from panic attacks, anxiety, depression, OCD and medical phobias. These issues have been going on for over a decade with no resolution in sight. The problems seemed to start just after a death in the family, and the anxiety just escalated from there until it turned into debilitating OCD, depression etc.

The largest obstacle to overcome seems to be the medical phobia. Because of this phobia, I can't get her to seek treatment, so one thing just escalates into another. At this point she barely speaks to people, doesn't watch television or read etc. This is because any word she associates with medicine sends her into an uncontrollable panic. The words don't have to be medical - she just has to be able to draw some sort of correlation – for instance, hospitality, sounds like hospital.

I've been researching healing with sound, music therapy and guided imagery. The one thing she will do is listen to music without words (since there aren't words to upset her).

Can you suggest anything that might help such an extreme case? She refuses treatment (because of her phobias) so I basically need something that will relax her and calm the fears without her thinking of it as treatment.

Basically, I need a stepping stone - something to get us past the first step so that maybe she'll eventually be more open to treatment, if only we can calm the medical phobia.

Do you have any CD's that might be appropriate? Or anything else? Thanks so much!

Harried Harry

Dear H.H.,

It sounds like you've had quite a challenge, and you've really hung in there. For starters (but only starters), the short answer is yes, we do have a CD for Obsessive Compulsive Disorder and another for Panic Attacks, and yet another for Depression, but in your wife's case, I suspect that they'll only be somewhat helpful. Her condition is too severe and it's been allowed to go on for too long.

I know this is going to sound cruel to you, but please hear me out. OCD gets worse when it's accommodated. It spreads, gets more generalized, more intense, more frequent and more debilitating if it's allowed to go on. In fact, you're describing this metastasis perfectly when you say it used to be the word "hospital" that would set off her panic; now it's even an associated word like "hospitality".

There is ample clinical evidence and research showing that tiptoeing around the constrictions of OCD is tantamount to dooming the OCD sufferer to get worse.

You're being held hostage by her distress, Harry, and the only way to help her is to liberate yourself and get some help for both of you. It will take a strong stomach, because her initial terror will be hard on you.

You need to either find an OCD specialist who knows effective, tried and true behavioral techniques (CBT or cognitive behavioral therapy), plus medication (SRI's or serotonin reuptake inhibitors are the preferred drugs for OCD – Anafranil, Luvox, Prozac, Zoloft and Paxil are examples – and this class of drug is also good for depression.)

Then you need to bring her to the therapist - whether she likes it or not. Maybe you can get some help from a relaxation CD but maybe not. Perhaps an OCD specialist will come to the house - they're used to dealing with phobias. But bottom line: she's now completely dependent on you, which means you have a lot of clout. You can get her to go if you sound like you mean it.

You also might want to pick up an excellent book called Freedom from Obsessive-Compulsive Disorder by Dr. Jonathan Grayson. You'll find some great orientation and coaching in there, to support the idea that you really must interrupt this co-dependent, enabling response of yours to her condition. It's a terrific book – the author has run a successful program for OCD sufferers for years, and it works because, to use a vivid Adlerian phrase, it "spits in the soup" of the sufferer and breaks the cycle. She may need to be hospitalized for a few weeks, but it will be worth it.

I hope you can do this. I know it will be difficult, but you're the one in the pivotal power position with more than enough leverage to help her get well.

My wife has had OCD (Obsessive-Compulsive Disorder) since at least 1963, along with deep depression. Though she will be in a program at UCLA and is under doctor's care, and I don't expect immediate "cures," is there anything else that might be helpful for her? And, honestly, I'm not all that hopeful about holistic medicine, but I feel we have to try all avenues.

Thank you.Jose M.

Dear Jose,

I'm guessing that some segments of the program your wife will be participating in at UCLA will provide selected mind-body training in relaxation, along with medication (probably from the class of drugs called SSRI's, such as Zoloft, Prozac, etc), cognitive-behavioral techniques, psycho-education and possibly group support – all of which can be extremely helpful over time.

You are wise to gear yourself not to expect a "silver bullet" that yields an instant cure – lasting positive changes tend to be incremental over time, not quick fixes. But if she sticks with the program, I think it's fair to say you both will see results.

If the UCLA program is very cutting edge, you can even expect to find one or more of the "Alphabet Therapies" – EMDR, EFT, SE or PET, to name a few, along with the other tools. These are imagery-based, short-term methods that can be very helpful in alleviating some of your wife's symptoms.

The truth is, any sort of mind-body self-regulation tool – guided imagery, meditation, breathwork, self-hypnosis – is going to help your wife manage and contain her anxiety, and this will help her to modulate her OCD as well.

The best approach is multi-modal, using many of these methods, and attacking the condition from many angles. Unless something extraordinary happens, it's safe to say that you can expect to see some improvement in the near future, and it should continue to get better over time. It's possible your wife will be quite improved, and maybe even symptom free.

So good for both of you. Stay with it. We also have some guided imagery specifically designed for OCD, that's named, not surprisingly, Help for Obsessive Compulsive Disorder. She may want to add that to her toolkit.

Again, expect change to be incremental. She just needs to listen regularly – once or twice a day is fine – for a few weeks. It doesn't matter if she falls asleep while she's listening. It will still sink in.

Now, I'm not sure what brought you to the point of seeking help after all these years – something must have changed – but it makes me want to offer one warning: her improvement will create some major changes in your relationship if she's been suffering from this for 60 years.

You are to be commended for being such a supportive and involved spouse, but it's possible that some phases of her treatment might require you to step back and let her do some heavy lifting without your guidance. Your job will be to step back and adjust to the changes – a significant challenge in and of itself. Even if the changes are long hoped for, positive ones, they will still take some getting used to!

You have NO IDEA how timely this post (The Joy of Tossing Clutter) is for me!! I just looked at the HJ site today hoping to find something to help w/ Procrastination because I look around my house...thinking I NEED to clean this junk and paper clutter out!!

Anything already in the HJ library that might help?

Thanks so much for your work!

Dana

Answer:

You’re very welcome, Dana.

Traci Stein, PhD, MPH, has created a terrific guided imagery/hypnosis recording for exactly what ails you – Guided Self-Hypnosis to Free Yourself from Procrastination. It’s very skillfully done, very effective, and has been flying off the shelves here, so you can take comfort in knowing that you’re certainly not alone!

We’re getting great feedback on it (You’ll see a some raves on the product page from people who took the time to post there).

Traci describes the contents like this:

This program is designed to help procrastinators put the most effective parts of the brain in the driver’s seat and develop the best strategies for getting things done. It draws from the latest research and features 2 hypnotic guided imagery tracks, plus a separate track of affirmations. Regular use can help listeners break large goals into discrete, manageable tasks; sharpen focus and concentration; clearly visualize the completed goal; increase feelings of confidence; and form healthy, well-timed work habits. (74 minutes)

I’d definitely give it a try.

Good luck with this!

(Really, start anywhere - a little corner, even!)

All best,

Belleruth

]]>design@emediacy.net (Belleruth Naparstek)Ask BelleruthSun, 11 May 2014 20:00:00 -0400How Can She Control Her Own Overly Aggressive Social Behavior? http://blog.healthjourneys.com/ask-belleruth/how-can-she-control-her-own-overly-aggressive-social-behavior.html
http://blog.healthjourneys.com/ask-belleruth/how-can-she-control-her-own-overly-aggressive-social-behavior.html

Question:

Dear BR,

I feel the opposite of the person who avoids rejection by avoiding people. I think I'm TOO outgoing and turn off people by being too in the middle of everything. How can I balance my social need with more subtle behavior? I’m in my forties.

Suzannah

Answer:

Dear Suzannah,

I take it that you know you have a problem because of the feedback you've gotten from other people, yes? But I'm not quite sure what you mean by "too outgoing" and "too in the middle of everything".

Do you scare people by being too socially aggressive? Do you break into conversations you don't belong in? Do you talk too much, not give people room to talk back? Or do you dead-end conversations by always bringing points people are trying to make about something back to a story about you? Do you share too much personal information about yourself too quickly? Do you get anxious if you're not the center of attention? Do you create drama and trouble by "kibbitzing" too much in other peoples' business?

These are all the ways I could interpret your question - some of the more commonplace ways people get themselves in trouble in the "too outgoing" department. Are you aware at the time of being "too outgoing" but can't seem to stop anyway?

This could be behavior you learned from a parent you've identified with, who acted this way; or it could be a kind of social naivete, from not having quite learned the rules (teenagers deal with this a lot but often outgrow it); or it could be the result of anxiety that you don't know how to contain but rather externalize and impulsively act out socially (This would be the most common cause for someone in their forties.)

Either way, you can unlearn this and get better control over it by, first and foremost, taking a deep breath and listening to people. You want to be more subtle? Listen. Set your intention to find the other person interesting, place your attention on comprehending them, give them room to talk and then ask clarifying questions about what they’re talking about, and short of doing this like a bulldozer, your responses will automatically become more subtle – and nice to be around.

The other thing is becoming aware of when you have an impulse to be "too outgoing" and instead turning inward and handling yourself and your own impulses, rather than making it an interactive behavior. Breathe deeply and place your attention (gently!) on what’s going on in your insides.

Becoming adept at mindfulness meditation would probably be just the ticket. It's a practice of constantly turning your attention inward, back to your insides, rather than keeping it on externals at the boundaries of your "self".

This would train you to stop putting your jumpy insides on the outside, where other people have to pick up the tab for them. Of course, this would run counter to your whole way of being with people, so you probably would find it uncomfortable at first. But that doesn't make it a bad idea. It's a great idea if you have the motivation and discipline for it. So that would be my first suggestion.

If mindfulness is too quiet for you, too demanding, too lonely, then some simple relaxation would be a help. You could practice relaxing to our Relaxation & Wellness imagery or General Wellness. Then you could put that relaxation to work in social situations.

But you'd still have to become aware of what's going inside of you so you can interrupt the self-defeating social behavior before it gets expressed externally. So awareness is going to be a key component, no matter what.

And that's a hard thing for somebody whose defense is to automatically and instantly translate their anxiety or discomfort into something interactive, before they even get to feel what they're feeling and identify what the heck it is. That's why you’ll need to be patient with yourself. And why mindfulness is my first choice.

Of course you could also appoint friends or a spouse (if they're not too critical) to act as your social feedback coach, signaling you in some predetermined gesture or comment when they see you heading in the wrong direction.

Or some therapy or life coaching groups with a strong group process component can also teach you new behavior. But since it's going to come down to self-awareness and self-discipline, I would encourage you to do the mindfulness work too.

You could join a mindfulness or vipassana meditation group; or we have some wonderful resources to help you at home. Jon Kabat-Zinn offers great instruction, as does Bodhipaksa in his excellent guided meditations. Give one of these a try and let me know how it goes.

First off, I'd like to offer my thanks to you for helping people all over the country with their emotional/mental troubles and needs. Unfortunately, I suffer from germaphobia accompanied by fear of illness. It’s so bad that I wash my hands constantly, avoid touching things when I’m out in public, and carry sanitizer around in my pocket. Plus, I don't go out to restaurants anymore, because I fear the people who made the food aren't careful with hygiene and contaminate my food with some kind of bacteria.

This all came about this past April, when I was very ill with a really bad stomach virus. It ended up being a very traumatic event for me, to say in the least... and I haven't been able to move on. I've tried everything I could afford -therapy, holistic medicine, acupuncture, meditation, etc. I'm tired of living with this constant fear - what do you recommend for someone with my case? Thank you very much. Feel free to post this.

Gary

Answer:

Dear Gary,

As I'm sure you already know, you're suffering from a classic case of OCD - obsessive compulsive disorder - which we now know is a neurological, not a psychological condition (although it certainly has its psychological effects, as you have unfortunately seen from the way it impedes your mood, activities and relationships). It runs in families, usually hits people in young adulthood, waxes and wanes with neurohormones, and basically means that the little brain switch that automatically discards random worries as irrelevant, isn't operating properly, so the worry doesn't shut off. In fact, the worries and the rituals heighten in importance the more you give in to them. That's why it's so crucial for you to get the right kind of help, to break up this cycle.

Even though this may have been set off by the stomach virus, that's not what's driving this thing, and psychological insight won't make it go away. Any therapist who tells you otherwise is not properly trained to help you with this. (We've learned so much, so quickly about the neurological and biochemical basis of conditions like OCD and PTSD, that many of my colleagues haven't had a chance to catch up with the latest discoveries. You may have been treated by professionals still caught in this unfortunate time lag.)

What does work for this condition is a combination of Cognitive Behavioral Therapy, medication and, of course, since this is an anxiety-propelled disorder, relaxation and guided imagery.

You absolutely can learn to manage and control this thing, so that it's not running your life. You may not be able to get rid of it altogether (although you might), but you can absolutely, substantially reduce these symptoms and get comfortable with your life again. But you need to find the right kind of expert help. Behavioral therapy trains you to face these demons, a little bit at a time, and extinguish the anxiety in a controlled way.

At first the therapy can make you more anxious, because you're not giving in to your obsessions and compulsions, but it's presented and dosed in a way that you can handle, especially if you've gained some skill at using the imagery and relaxation techniques to help you handle the initial distress.

The sooner you tackle this, the better, because, if left on its own, the trajectory only gets worse and worse. So get cracking! Find an expert in OCD who uses this combination – I repeat: (1) CBT, (2) medication and (3) mind-body relaxation techniques.

Most teaching hospitals will have an anxiety clinic or panic disorder clinic. Some even provide residential care to help you over the hump if you feel you’ll need a lot of structure and support.

You can also get a treatment plan from a good book, such as Jonathan Grayson's Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living with Uncertainty.

Researchers from the Karolinska Institutet in Stockholm, Sweden investigated the efficacy of internet-based cognitive behavioral therapy (ICBT) with therapist support for obsessive compulsive disorder. CBT is widely regarded as an effective treatment for OCD, but access to CBT therapists is limited – thus the internet-based program as an intermediate solution.

This pilot was an open trial where 23 patients received a 15-week ICBT program with therapist support, consisting of psycho-education, cognitive restructuring and exposure with response prevention.

The primary measure of outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment.

All participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohen's d = 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression.

This pilot demonstrated the impressive promise of ICBT, combined with therapist support, for reducing OCD symptoms, depressive symptoms and improving general functioning. Follow-up with randomized, controlled trials are needed to confirm the effectiveness of this new treatment format.

I have been listening to your DVD [Ed. Note: she means CD] on OCD [Obsessive Compulsive Disorder] and I can finally feel relief. I’m not sure how it works but I know it does like nothing has before.

I do take Zoloft [Ed. Note: an SSRI or sustained serotonin reuptake inhibitor for depression] and Lorazepam [Ed Note: brand name is Ativan, a sedating, muscle- relaxing, anti-anxiety agent], but not till I started listening to your OCD dvd [sic] did my mind and outlook and thinking change. It is so nice. I can't thank you enough.

You have NO IDEA how timely this post (The Joy of Tossing Clutter) is for me!! I just looked at the HJ site today hoping to find something to help w/ Procrastination because I look around my house...thinking I NEED to clean this junk and paper clutter out!!

Anything already in the HJ library that might help?

Thanks so much for your work, you've blessed my life over and over!

Dana

Answer:
Thank you very much, Dana.
Hmmm... David Illig has a Procrastination CD, I know. We don’t carry this particular CD because we don’t include subliminal titles, just as a matter of general policy. But I like his work very much.

The only thing HJ has that comes close is the Weight Loss imagery, which uses losing weight as a general metaphor for shedding and clearing out everything, inside and outside - but we have nothing more targeted than that.

I found David Illig's site & it looks to have some good stuff. What's your thoughts on subliminal learning programs? I'm aware you don't use them in your CD's.

Dana

BR replies:

Dana,
You’re right, we don’t carry subliminal programs - mostly because they don’t have the kind of evidence-based track record that we find in the research on spoken word hypnosis and imagery. And I also don’t like the idea of selling a program where we’re not entirely certain of what’s on it.

But I do trust David Illig. He's been around for a while and he’s very skillful at what he does. And he sent me the “cheat sheet” that spells out what the subliminal messages are, and they're simple, affirming and positive (and you can catch some of the phrases in there anyway.) Hope this helps.

My wife suffers from panic attacks, anxiety, depression, OCD and medical phobias. These issues have been going on for over a decade with no resolution in sight. The problems seemed to start just after a death in the family, and the anxiety just escalated from there until it turned into debilitating OCD, depression etc.

The largest obstacle to overcome seems to be the medical phobia. Because of this phobia I can't get her to seek treatment, so one thing just escalates into another. At this point she barely speaks to people, doesn't watch television or read etc. This is because any word she associates with medicine sends her into an uncontrollable panic. The words don't have to be medical - she just has to be able to draw some sort of correlation – for instance, hospitality, sounds like hospital.

I've been researching healing with sound, music therapy and guided imagery. The one thing she will do is listen to music without words (since there aren't words to upset her).

Can you suggest anything that might help such an extreme case? She refuses treatment (because of her phobias) so I basically need something that will relax her and calm the fears without her thinking of it as treatment.

Basically, I need a stepping stone - something to get us past the first step so that maybe she'll eventually be more open to treatment, if only we can calm the medical phobia.

Do you have any CD's that might be appropriate? Or anything else? Thanks so much!

Harried Harry

Dear H.H.,

For starters (but only starters), the short answer is yes, we do have a CD for Obsessive Compulsive Disorder and another for Panic Attacks, and yet another for Depression, but in your wife’s case, I suspect that they’ll only be somewhat helpful. Her condition is too severe and it’s been allowed to go on for too long.

I know this is going to sound cruel to you, but please hear me out. OCD gets worse when it’s accommodated. It spreads, gets more generalized, more intense, more frequent and more debilitating if it’s allowed to go on. In fact, you’re describing this metastasis perfectly when you say it used to be the word “hospital” that would set off her panic; now it’s even a derivative word like “hospitality”.

There is ample clinical evidence and research showing that tiptoeing around OCD limitations is tantamount to dooming the OCD sufferer to get worse. In fact, a brand new study just hit the Pubmed database this week, saying this very same thing about pediatric OCD – when the family accommodates the symptoms, the symptoms stick or worsen, even in spite of treatment. (That citation, if you’re interested, is Merlo LJ, Lehmkuhl HD, Geffken GR, Storch EA. Decreased family accommodation associated with improved therapy outcome in pediatric obsessive-compulsive disorder. Journal of Consulting & Clinical Psychology. 2009 Apr;77 (2):355-60.)

You’re being held hostage by her distress, Harry, and the only way to help her is to liberate yourself and get some help for both of you. It will take a strong stomach, because her initial terror will be hard for you to take. You need to either find an OCD specialist who knows effective tried and true behavioral techniques, with access to medication, and bring her there with or without her compliance, possibly with the help of a relaxation CD (or they can come to the house - they're used to dealing with phobias); or else pick up Freedom from Obsessive-Compulsive Disorder by Dr. Jonathan Grayson for some preliminary coaching and help with understanding why you need to interrupt this co-dependent response. It’s a terrific book – he’s run a successful program for OCD sufferers for years, and it works because, to use a vivid Adlerian phrase, it “spits in the soup” of the sufferer and breaks the cycle. She may need to be hospitalized for a few weeks, but it will be worth it.

I hope you can do this. I know it will be difficult, but you're the one in the pivotal position with sufficient leverage to help her break the cycle.

Question: Dear Belleruth, thank you so much for your work. I am in the process of conquering anxiety and my therapist suggested I explore some of your Health Journeys. I love listening and repeating the affirmations in my car on my way to work. I notice a difference already only after 3 days!

I was not officially diagnosed with OCD but was told by my doctor that I have OCD tendencies. Would it be alright for me to use the OCD imagery or is this only for people who have been officially diagnosed? Also, I suffer from health anxiety. Do you have any specific recommendations for dealing with this form of anxiety? Thank you again, you have been an integral part of my transition and healing.

Alessandra

Dear Alessandra,
I’m glad the affirmations are helping. It can be really astonishing how such a small “dose” of imagery – just a few minutes – can go such a long way in lowering anxiety. It still surprises me, and I should know by now.

To answer your question, when all is said & done, anxiety is anxiety. For your purposes, there’s no need differentiate it by type, or to parse it out by what it focuses on. Nor is there any value in doing so. OCD is an anxiety-based condition – with a lot of genetic predisposition driving it – so anything you do for general anxiety would be helpful for OCD. The same is true for your health-focused anxiety.

The fact that you’re worrying about these different types of anxiety and whether you should be doing different things for each them is a possible indicator that you might indeed have a little OCD. But either way, if you focus on easing your general anxiety, you’ll be on the right track.

The actual OCD imagery could be a nice alternate for you to use when you get bored with the Affirmations or the Relaxation and Wellness imagery. It won’t hurt you to use it if you don’t have the official diagnosis, and it’s probably got some imagery that’s on target for you. The main thing to keep in mind is that anything you do that eases your anxiety – including exercise, breathwork, mindfulness meditation, yoga, massage therapy and all manner of imagery – is all good!